在经过腹腔镜辅助全胃切除术的患者中,外科手术期间低剂量纳洛对免疫系统的影响:一项随机对照试验
Xiangzhen Min1,2, Yan Ma3, Yufang Leng4
1The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China.
BMC anesthesiology
|May 9, 2024
概括
低剂量纳洛 (LDN) 降低了腹腔镜全胃切除术的胃癌患者的感染率. LDN还调节了免疫细胞种群,增强了手术后的自然杀手 (NK) 和CD8+ T细胞数量.
科学领域:
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
- 手术创新 在外科创新.
背景情况:
- 腹腔镜全胃切除术可能会损害免疫功能,增加感染风险.
- 低剂量纳洛 (LDN) 在治疗慢性炎症和自身免疫性疾病方面表现有前途.
- 术后的LDN可以缓解大手术后的并发症.
研究的目的:
- 研究LDN对胃癌患者内源性免疫功能的影响.
- 阐明LDN在外科手术期间影响免疫反应的具体机制.
- 通过随机对照试验评估LDN在腹腔镜辅助全胃切除术后减少并发症的有效性.
主要方法:
- 一项随机对照试验,涉及55名接受腹腔镜辅助全胃切除术的患者.
- 患者通过患者控制的静脉注射 (PCIA) 从手术前3天到手术后5天接受LDN (0.05μg/kg/h) 或安慰剂.
- 通过分析NK细胞,CD3+,CD4+,CD8+T细胞,白细胞计数,中性粒细胞百分比,IL-6和素水平来评估免疫功能. 还评估了TLR4,IL-6和TNF-α的瘤组织表达.
主要成果:
- 与对照组相比,LDN组的切口,腹部和肺部感染率明显较低 (P <0.05).
- 在手术后24小时和96小时的LDN组,NK细胞和CD8+T细胞的数量显著更高 (P<0.05).
- 相反,手术后24小时CD3+和CD4+T细胞计数在LDN组较低 (分别P<0.05和P<0.01).
- 在手术后24小时和96小时,非纳洛组的白血球数量和中性粒细胞百分比升高 (P < 0.05).
- 在手术后24小时,非纳洛组的IL-6和素水平显著高于非纳洛组 (P <0.05).
- 胃癌组织在LDN组显示TLR4表达增加,但与非纳洛组相比IL-6和TNF-α表达减少 (P <0.05).
结论:
- 术后的LDN给药 (0.05μg/kg/h) 对经过腹腔镜全胃切除术的患者有益,降低了感染风险.
- LDN可能调节免疫细胞种群,包括NK细胞,CD3+,CD4+和CD8+T细胞.
- LDN的机制可能涉及改变托尔类受体4 (TLR4) 表达和随后的免疫细胞活性.
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